Title

Effect of Use of a Bougie vs Endotracheal Tube With Stylet on Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial.

Authors

Brian E Driver, Hennepin County Medical Center, Minneapolis, MN
Matthew W Semler, Vanderbilt University Medical Center
Wesley H Self, Vanderbilt University Medical Center
Adit A Ginde, University of Colorado School of Medicine, Aurora
Stacy A Trent, University of Colorado School of Medicine, Aurora
Sheetal Gandotra, University of Alabama at Birmingham
Lane M Smith, Wake Forest Baptist Health
David B Page, University of Alabama at Birmingham
Derek J Vonderhaar, LSU Health Sciences Center - New OrleansFollow
Jason R West, Lincoln Medical Center, Bronx, New York
Aaron M Joffe, University of Washington, Seattle
Steven H Mitchell, University of Washington, Seattle
Kevin C Doerschug, University of Iowa
Christopher G Hughes, Vanderbilt University Medical Center
Kevin High, Vanderbilt University Medical Center
Janna S Landsperger, Vanderbilt University Medical Center
Karen E Jackson, Vanderbilt University Medical Center
Michelle P Howell, University of Colorado School of Medicine, Aurora
Sarah W Robison, University of Alabama at Birmingham
John P Gaillard, Wake Forest Baptist Health
Micah R Whitson, University of Alabama at Birmingham
Christopher M Barnes, University of Washington, Seattle
Andrew J Latimer, University of Washington, Seattle
Vikas S Koppurapu, University of Iowa
Bret D Alvis, Vanderbilt University Medical Center
Derek W Russell, University of Alabama at Birmingham
Kevin W Gibbs, Wake Forest School of Medicine
Li Wang, Vanderbilt University Medical Center
Christopher J Lindsell, Vanderbilt University Medical Center
David R Janz, LSU Health Sciences Center - New OrleansFollow
Todd W Rice, Vanderbilt University Medical Center
Matthew E Prekker, Hennepin County Medical Center, Minneapolis, MN

Document Type

Article

Publication Date

12-8-2021

Publication Title

JAMA: Journal of the American Medical Association

Abstract

Importance: For critically ill adults undergoing emergency tracheal intubation, failure to intubate the trachea on the first attempt occurs in up to 20% of cases and is associated with severe hypoxemia and cardiac arrest. Whether using a tracheal tube introducer ("bougie") increases the likelihood of successful intubation compared with using an endotracheal tube with stylet remains uncertain.Objective: To determine the effect of use of a bougie vs an endotracheal tube with stylet on successful intubation on the first attempt.Design, Setting, and Participants: The Bougie or Stylet in Patients Undergoing Intubation Emergently (BOUGIE) trial was a multicenter, randomized clinical trial among 1102 critically ill adults undergoing tracheal intubation in 7 emergency departments and 8 intensive care units in the US between April 29, 2019, and February 14, 2021; the date of final follow-up was March 14, 2021.Interventions: Patients were randomly assigned to use of a bougie (n = 556) or use of an endotracheal tube with stylet (n = 546).Main Outcomes and Measures: The primary outcome was successful intubation on the first attempt. The secondary outcome was the incidence of severe hypoxemia, defined as a peripheral oxygen saturation less than 80%.Results: Among 1106 patients randomized, 1102 (99.6%) completed the trial and were included in the primary analysis (median age, 58 years; 41.0% women). Successful intubation on the first attempt occurred in 447 patients (80.4%) in the bougie group and 453 patients (83.0%) in the stylet group (absolute risk difference, -2.6 percentage points [95% CI, -7.3 to 2.2]; P = .27). A total of 58 patients (11.0%) in the bougie group experienced severe hypoxemia, compared with 46 patients (8.8%) in the stylet group (absolute risk difference, 2.2 percentage points [95% CI, -1.6 to 6.0]). Esophageal intubation occurred in 4 patients (0.7%) in the bougie group and 5 patients (0.9%) in the stylet group, pneumothorax was present after intubation in 14 patients (2.5%) in the bougie group and 15 patients (2.7%) in the stylet group, and injury to oral, glottic, or thoracic structures occurred in 0 patients in the bougie group and 3 patients (0.5%) in the stylet group.Conclusions and Relevance: Among critically ill adults undergoing tracheal intubation, use of a bougie did not significantly increase the incidence of successful intubation on the first attempt compared with use of an endotracheal tube with stylet.Trial Registration: ClinicalTrials.gov Identifier: NCT03928925.

First Page

2488

PubMed ID

34879143

Volume

326

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